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NPI Code Detail

MEDICARE: BRANDI MICHELLE AZEVEDO

MEDICARE:   BRANDI MICHELLE AZEVEDO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1174400000XSpecialist5527CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
15527OTHERCACAS

General Provider Information

NPI Number : 1588781520
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRANDI MICHELLE AZEVEDO
Provider Business Mailing Address
First Line : PO BOX 586
Second Line :
City : CAMINO
State : CA
Zip : 95709-0586
Country : US
Telephone Number : 530-306-1896
Fax Number :
Provider Business Practice Location Address
First Line : 1360 GRAY AVE
Second Line : APARTMENT B
City : YUBA CITY
State : CA
Zip : 95991-3242
Country : US
Telephone Number : 530-306-1896
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/23/2007
Last Update Date : 07/08/2007

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Directions to “ BRANDI MICHELLE AZEVEDO ” Practice Location

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